| NPI | 1720495989 |
|---|---|
| Former Name | KRISTINA JACOBSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2023-03-06 |