NPI | 1740742766 |
---|---|
Former Name | PERSIS CELINA PUELLO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155116) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME155116) |
Enumeration Date | 2019-04-01 |
Last Update Date | 2025-09-24 |