NPI | 1013335520 |
---|---|
Former Name | LAURA DAVIS SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 62902) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-04-01 |
Last Update Date | 2022-07-21 |