NPI | 1154301455 |
---|---|
Former Name | CHRISTA MAE THOMASMA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01062526A) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01062526A) |
207Q00000X Family Medicine (Licence: WI 73469-20) | |
Enumeration Date | 2006-01-20 |
Last Update Date | 2024-01-18 |