NPI | 1023375664 |
---|---|
Former Name | KARIN LYNN DEJONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 59604) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 59604) |
207QS0010X Family Medicine, Sports Medicine (Licence: CO 59604) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-04-20 |
Last Update Date | 2022-11-04 |