| NPI | 1801114624 |
|---|---|
| Former Name | JACQUELYN SUZANNE BERTELLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: NY 272160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 272160) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2015-08-31 |