| NPI | 1699906792 |
|---|---|
| Former Name | KATIE M TYRRELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA053899) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA OA002369) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2012-07-17 |