| NPI | 1801456421 |
|---|---|
| Former Name | CARISSA ANTONIA SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS022184) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2022-08-12 |