| NPI | 1073509220 |
|---|---|
| Former Name | STEPHANIE ANNE FAVALORO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K2715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 37247) |
| 207Q00000X Family Medicine (Licence: AL 24750) | |
| 207Q00000X Family Medicine (Licence: GA 051333) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-07-06 |