| NPI | 1952544199 |
|---|---|
| Former Name | THERESA HANSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01072785A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 048872) |
| 207Q00000X Family Medicine (Licence: CO 45999) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 01072785A) | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2023-11-27 |