| NPI | 1053546507 |
|---|---|
| Former Name | CRYSTAL MONIQUE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 202001935) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD040888) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2021-11-16 |