NPI | 1124550736 |
---|---|
Former Name | KALLAN SIAN ROSS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 94701) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-21180) |
Enumeration Date | 2017-04-02 |
Last Update Date | 2023-03-27 |