NPI | 1932122439 |
---|---|
Former Name | TRISTYN AMY CYRIAC |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-32917) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00046116) |
208000000X Pediatrics (Licence: KS 04-32917) | |
Enumeration Date | 2006-07-25 |
Last Update Date | 2014-06-09 |