NPI | 1164680518 |
---|---|
Former Name | JESSICA CARRIE DINGMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.120322) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD036380) |
Enumeration Date | 2008-06-01 |
Last Update Date | 2021-04-28 |