NPI | 1932580263 |
---|---|
Former Name | DYLAN TRACY |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61102294) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1646) |
207Q00000X Family Medicine (Licence: IL 125067436) | |
Enumeration Date | 2015-06-11 |
Last Update Date | 2021-09-16 |