NPI | 1154683290 |
---|---|
Former Name | MARY KATE ROD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 18176) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 252007) |
Enumeration Date | 2012-06-14 |
Last Update Date | 2022-07-21 |