| NPI | 1578556833 |
|---|---|
| Former Name | ELIZABETH NICOLE BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA md00045393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M9634) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-03-06 |