| NPI | 1720516719 |
|---|---|
| Former Name | AMANDA MICHELLE GRIESBAUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125070520) |
| 207Q00000X Family Medicine (Licence: AR E-13398) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2021-02-01 |