| NPI | 1083235592 |
|---|---|
| Former Name | JENNIFER MICHELLE BERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 68123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R77940) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2023-10-19 |