| NPI | 1750761532 |
|---|---|
| Former Name | GRACE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MO 2021030232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015017097) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2021-10-25 |