| NPI | 1457616997 |
|---|---|
| Former Name | MARISSA LYN BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A142166) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ 207ZP0102X) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2021-12-22 |