| NPI | 1619288438 |
|---|---|
| Former Name | MARY BLAIR-GISCOMBE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: CA A138664) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R72272) |
| 208000000X Pediatrics (Licence: MS 22766) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-02-11 |