| NPI | 1174214506 |
|---|---|
| Former Name | ALTA ROSE GILLHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351050919) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2024-06-19 |