NPI | 1487041455 |
---|---|
Former Name | JESSIE ELIZABETH EVANGELISTA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MI 4301115925) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-04-17 |
Last Update Date | 2021-05-17 |