NPI | 1407355597 |
---|---|
Former Name | CHANNING BOWERS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 16346) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
171000000X Military Health Care Provider (Licence: SC 83334) | |
Enumeration Date | 2018-02-05 |
Last Update Date | 2024-05-29 |