| NPI | 1467714253 |
|---|---|
| Former Name | CRYSTAL ANN GORDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: WA OP61260688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R9463) |
| 207RN0300X Internal Medicine, Nephrology (Licence: MA 263624) | |
| 207RN0300X Internal Medicine, Nephrology (Licence: AL DO.1714) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2022-07-20 |