| NPI | 1801877923 |
|---|---|
| Former Name | COLEEN M JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: IL 036113689) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MO 2004001641) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-07-27 |