| NPI | 1124283387 |
|---|---|
| Former Name | JESSICA SHANK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX F0635) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: DC B07904445-J0441) |
| Enumeration Date | 2008-07-26 |
| Last Update Date | 2017-01-16 |