NPI | 1154314771 |
---|---|
Former Name | MICHELE EVYAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 28201) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 15282) |
Enumeration Date | 2005-08-30 |
Last Update Date | 2016-10-25 |