| NPI | 1578806840 |
|---|---|
| Former Name | JACLYN SUSAN OLSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CT 056802) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2023-09-14 |