| NPI | 1902339047 |
|---|---|
| Former Name | HOLLY ELIZABETH BACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020027000) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2024-08-22 |