| NPI | 1194254367 |
|---|---|
| Former Name | LISA WADOWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036167745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020030109) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2025-09-22 |