| NPI | 1063522167 |
|---|---|
| Former Name | LYDIA MONIQUE REASONOVER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301076458) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-08-05 |