| NPI | 1083233258 |
|---|---|
| Former Name | HOLLY RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP70007005) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OL61300618) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-05-06 |