NPI | 1316423056 |
---|---|
Former Name | BRIA HANNEMAN RAYOME |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 72307) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-07-16 |
Last Update Date | 2022-11-30 |