NPI | 1871097238 |
---|---|
Former Name | TYAJEAN OLIVE MABEE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-100286) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-67462) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-03-21 |
Last Update Date | 2021-08-11 |