| NPI | 1316359854 |
|---|---|
| Former Name | JACQUELINE SUSAN LAROUERE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101021108) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021108) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2021-03-29 |