| NPI | 1841485018 |
|---|---|
| Former Name | CRYSTAL SHANELLE CARAWAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 44247) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101247662) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2023-08-04 |