| NPI | 1629360342 |
|---|---|
| Former Name | AVERY L SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 1481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6455) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2015-03-23 |