| NPI | 1407902174 |
|---|---|
| Former Name | AMANDA MARIE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OK 25844) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 25844) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2019-12-13 |