| NPI | 1245221233 |
|---|---|
| Former Name | MARIANNE BLACKMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 114452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-26395) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2016-11-07 |