| NPI | 1316380439 |
|---|---|
| Former Name | TARA K BAGEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME134360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R2811) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2022-03-23 |