NPI | 1811380231 |
---|---|
Former Name | CRYSTAL VAHRENHOLD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2146) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL TA.1793) |
Enumeration Date | 2015-03-10 |
Last Update Date | 2024-12-02 |