NPI | 1184065930 |
---|---|
Former Name | JESSICA LAUREN WALL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 145258) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116026459) |
Enumeration Date | 2013-07-09 |
Last Update Date | 2024-07-25 |