| NPI | 1104569219 |
|---|---|
| Former Name | MIKAYLA LAUREN PETESCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2023022504) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-04-16 |
| Last Update Date | 2023-06-27 |