| NPI | 1063576429 | 
|---|---|
| Former Name | ELIZABETH MAE FOWLERSMITH | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL ME151404)  | 
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 7067820)  | 
| Enumeration Date | 2006-12-20 | 
| Last Update Date | 2023-03-22 |