NPI | 1144370750 |
---|---|
Former Name | TISHA DARICE MILLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2007013996) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-31678) |
Enumeration Date | 2007-01-12 |
Last Update Date | 2022-12-15 |