| NPI | 1912936279 |
|---|---|
| Former Name | ALYSIA NICOLE FURGATCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M1687) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX M6128) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2017-05-01 |