NPI | 1053848879 |
---|---|
Former Name | KASEY RADICIC |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A2018686) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2017-05-11 |
Last Update Date | 2023-04-25 |