| NPI | 1003220799 |
|---|---|
| Former Name | JESSICA PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 61656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10068) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2018-01-23 |