NPI | 1215431960 |
---|---|
Former Name | MARISSA LUCK BONUS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology (Licence: OR MD209009) |
Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD209009) |
Enumeration Date | 2018-03-19 |
Last Update Date | 2025-05-13 |