NPI | 1740360197 |
---|---|
Former Name | ERICA LYN ESSELSTROM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60097510) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO TL-2113) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2020-10-07 |