| NPI | 1386830610 |
|---|---|
| Former Name | JESSIE MARIE ROBERTS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: WA MD 60141711) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 60141711) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2021-04-07 |