NPI | 1609287846 |
---|---|
Former Name | VANESSA MERVYN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18775) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 291090) |
Enumeration Date | 2014-05-09 |
Last Update Date | 2021-08-30 |