NPI | 1548338619 |
---|---|
Former Name | CHANTE MONIQUE ELLISON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1595) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052351) |
Enumeration Date | 2006-11-30 |
Last Update Date | 2015-08-17 |