| NPI | 1538323845 |
|---|---|
| Former Name | REVITAL LEAH GORODESKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: OH 35.091752) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35091030) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2010-05-21 |