| NPI | 1598154197 |
|---|---|
| Former Name | PHOEBE BACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 272186) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2022-07-21 |