NPI | 1760137400 |
---|---|
Former Name | KATHERINE BRYANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12494156-1206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 12494156-1206) |
Enumeration Date | 2022-02-21 |
Last Update Date | 2025-07-29 |