NPI | 1235456955 |
---|---|
Former Name | REBECCA TYSON CORNELISON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 266403) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2010-04-21 |
Last Update Date | 2023-03-21 |