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 |