| NPI | 1881892552 |
|---|---|
| Former Name | KIMBERLY ANITRA MCCULLOUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 21233) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090322) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2018-06-22 |