| NPI | 1922116763 |
|---|---|
| Former Name | KRISTIN SUZANNE TATE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 107123) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 69818-20) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-10-11 |