| NPI | 1134482474 |
|---|---|
| Former Name | KATHERINE LEIGH RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 36193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025003) |
| 207Q00000X Family Medicine (Licence: GA 077163) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-07-16 |