| NPI | 1740253608 |
|---|---|
| Former Name | CAROLYN JEAN BLEAU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0102204226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9213) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2025-02-04 |