NPI | 1699061218 |
---|---|
Former Name | MISTEE MICHELLE RICHARDSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-37623) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011017922) |
Enumeration Date | 2011-06-22 |
Last Update Date | 2018-10-22 |