| NPI | 1982990453 |
|---|---|
| Former Name | CRYSTAL ANN FESENBEK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID O-1357) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 7704) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR DO170871) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-05-14 |