NPI | 1811588494 |
---|---|
Former Name | KATLYN ANN BOBOS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 085009225) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-01-27 |
Last Update Date | 2023-01-11 |