| NPI | 1396945317 |
|---|---|
| Former Name | ANGELIQUE RENAE DENAXAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2010-01605) |
| 208D00000X General Practice (Licence: NC 2010-01605) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2023-03-07 |