| NPI | 1972802429 |
|---|---|
| Former Name | TYRA LEIGH THORSTAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0064196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60390251) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2020-07-20 |