| NPI | 1043266562 |
|---|---|
| Former Name | CHANEL MARIE VANDEWEGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CO DR.0044171) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 31232) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 23689) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2015-07-09 |