NPI | 1154959534 |
---|---|
Former Name | CASSANDRA M BORMANN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-17339) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61490378) |
Enumeration Date | 2020-03-31 |
Last Update Date | 2023-11-21 |