| NPI | 1366825234 |
|---|---|
| Former Name | MARIAM BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6840) |
| 207Q00000X Family Medicine (Licence: OK 5940) | |
| 207Q00000X Family Medicine (Licence: OK 0097R) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2025-06-19 |