NPI | 1992099402 |
---|---|
Former Name | STEPHANIE LANAE HULSTEIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IA 10561) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA R-9147) |
207Y00000X Otolaryngology (Licence: SD 43079) | |
Enumeration Date | 2011-06-01 |
Last Update Date | 2022-09-30 |