| NPI | 1710399548 |
|---|---|
| Former Name | AMY FOGELSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 53383) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0052818) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2024-01-25 |