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 |