| 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 |