| NPI | 1851854079 |
|---|---|
| Former Name | KIMBERLY JANE UNDERWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2022-02584) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 250878) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2023-08-23 |