| NPI | 1275996076 |
|---|---|
| Former Name | VICTORIA ANNE BODENDORFER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 68327) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-01-28 |