NPI | 1891725495 |
---|---|
Former Name | KELLI CRAWFORD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003485) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MI 5601003485) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2017-01-05 |