| NPI | 1699074088 |
|---|---|
| Former Name | JACQUELINE BACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2011020297) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011020297) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2020-12-02 |