| NPI | 1619555216 |
|---|---|
| Former Name | KIA SHALYN BOURDOT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA12291200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC bour-9lqe07) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-03-24 |