| NPI | 1760746408 |
|---|---|
| Former Name | MARLA MICKEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105799) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME105799) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2023-01-26 |