| NPI | 1972762995 |
|---|---|
| Former Name | LAINE MONTGOMERY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D72798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101249806) |
| 207Q00000X Family Medicine (Licence: DC MD040239) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2021-06-21 |