| NPI | 1578322285 |
|---|---|
| Former Name | MICHELLE PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 125.086882) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2025-06-24 |