| NPI | 1386104511 |
|---|---|
| Former Name | TERESA CHUNG PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61320482) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60969730) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-08-01 |