NPI | 1053996397 |
---|---|
Former Name | MICHELLE R GRIMSLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: IL 164004672) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2007027443) |
133V00000X Dietitian, Registered (Licence: IA 096391) | |
Enumeration Date | 2021-03-17 |
Last Update Date | 2021-03-17 |