| NPI | 1235758061 |
|---|---|
| Former Name | DOMONIQUE JACQUELINE MARQUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0448232) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-04-12 |
| Last Update Date | 2023-08-14 |