| NPI | 1861786147 |
|---|---|
| Former Name | JACQUELINE JULIA LIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 1010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1010) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2024-04-09 |