NPI | 1568726792 |
---|---|
Former Name | JENNA B. WISSOCKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301101274) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301101274) |
Enumeration Date | 2012-07-03 |
Last Update Date | 2015-09-30 |