| NPI | 1992861751 |
|---|---|
| Former Name | COURTNEY BAIN LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NC 2012-01591) |
| Additional Taxonomies | 2085R0001X (Licence: MD D69615) |
| 2085R0001X (Licence: PA MT182964) | |
| 2085R0001X (Licence: PA MD427420) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2021-03-30 |