| NPI | 1578803862 |
|---|---|
| Former Name | ANDREA LAUREN RAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 35386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL35386) |
| 207Q00000X Family Medicine (Licence: SC 35386) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2021-05-26 |