| NPI | 1851015218 |
|---|---|
| Former Name | MCKENZE MARIE QUALKINBUSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003702A) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: IN 10003702A) |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2023-05-31 |