NPI | 1194743302 |
---|---|
Former Name | TAWANNA O GORDON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101244776) |
Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 055753) |
207V00000X Obstetrics & Gynecology (Licence: PA MD424859) | |
Enumeration Date | 2006-07-17 |
Last Update Date | 2023-03-07 |