| NPI | 1336534775 |
|---|---|
| Former Name | CAITLIN LAURA NICKOLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A146233) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2018-08-10 |