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 |