| NPI | 1245405125 |
|---|---|
| Former Name | GUSTI NUESSLE LICKFIELD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MBO5791100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OSO11024L) |
| 207Q00000X Family Medicine (Licence: MD H0066773) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |