| NPI | 1457779100 |
|---|---|
| Former Name | TARA NICOLE NIKONOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MT206574) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2022-07-21 |