| NPI | 1710244405 |
|---|---|
| Former Name | KATELYN MALO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006363) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2019-06-27 |