NPI | 1689194649 |
---|---|
Former Name | AUDREY WILKERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02006057A) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10937) |
Enumeration Date | 2017-06-21 |
Last Update Date | 2022-07-21 |