| NPI | 1730373259 |
|---|---|
| Former Name | KATHLEEN ANN CARROLL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036119323) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-049243) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2020-01-13 |