| NPI | 1467751859 |
|---|---|
| Former Name | JENNIFER HICKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 070050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS14110) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2022-08-08 |