| NPI | 1518209394 |
|---|---|
| Former Name | LAURA MIRIELLE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 312397) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2019-10-24 |