NPI | 1215342852 |
---|---|
Former Name | AMANDA MAE PALICH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 54116) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 37073) |
Enumeration Date | 2014-06-23 |
Last Update Date | 2019-09-19 |