NPI | 1548459159 |
---|---|
Former Name | SUSAN D KEASLING |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25052) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 49321) |
Enumeration Date | 2007-10-19 |
Last Update Date | 2016-07-19 |