NPI | 1164954038 |
---|---|
Former Name | TIFFANY DOOD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 88064) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207Q00000X Family Medicine (Licence: CO DR0061746) | |
Enumeration Date | 2017-03-30 |
Last Update Date | 2020-06-23 |