| NPI | 1053985192 |
|---|---|
| Former Name | JOSHUA DEREK MACK URSUA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-05-18 |