NPI | 1548245012 |
---|---|
Former Name | SHANNON J KOWAL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 40982) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q5925) |
Enumeration Date | 2005-12-07 |
Last Update Date | 2019-10-01 |