NPI | 1821603978 |
---|---|
Former Name | KELLY CHRISTINE WILKINS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60328) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA60328) |
Enumeration Date | 2020-09-14 |
Last Update Date | 2023-12-06 |