| NPI | 1619001211 |
|---|---|
| Former Name | MYRA ATHENA WITHERSPOON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD032271E) |
| 207Q00000X Family Medicine (Licence: SC 23426) | |
| 207Q00000X Family Medicine (Licence: GA 045152) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2013-03-15 |