| NPI | 1184004103 |
|---|---|
| Former Name | LEAH EVE MICKELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 79851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 209826) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-07-27 |