NPI | 1467604942 |
---|---|
Former Name | AJA MONTGOMERY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003917A) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02003917A) |
207R00000X Internal Medicine (Licence: MI 5101018023) | |
Enumeration Date | 2008-10-16 |
Last Update Date | 2023-05-21 |