| NPI | 1699331199 |
|---|---|
| Former Name | GRACE ANTONIA DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-11466) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-11466) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2019-05-10 |