NPI | 1861757080 |
---|---|
Former Name | KRISTINA LEA MALLECK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003478) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0003478) |
Enumeration Date | 2012-07-13 |
Last Update Date | 2024-04-09 |