| NPI | 1699761700 |
|---|---|
| Former Name | LESLIE D TACKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX M1074) |
| Additional Taxonomies | 2088P0231X (Licence: TX M0174) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2016-10-12 |