| NPI | 1447577424 |
|---|---|
| Former Name | JESSICA MARIE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 1761) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA DO-04367) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 1761) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2022-12-05 |