| NPI | 1760881056 |
|---|---|
| Former Name | KAITLIN INGHRAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 2571) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-005117) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2016-10-25 |