| NPI | 1588305759 |
|---|---|
| Former Name | MIKALA RAE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.032618) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58.032618) |
| Enumeration Date | 2022-04-04 |
| Last Update Date | 2022-07-01 |