| NPI | 1790219509 |
|---|---|
| Former Name | ELIZABETH ANNE MONTGOMERY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61061916) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2020-12-11 |