NPI | 1154540193 |
---|---|
Former Name | POTACIA WYNETTE BRISTOL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD459185) |
Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: GA 63330) |
207V00000X Obstetrics & Gynecology (Licence: NY 243207-1) | |
Enumeration Date | 2007-04-25 |
Last Update Date | 2024-08-08 |