| NPI | 1962740852 |
|---|---|
| Former Name | KRISTYN MARIE GENRICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004542) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 385003266) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085004542) | |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2022-03-16 |