| NPI | 1609213560 |
|---|---|
| Former Name | JACLYN CHRISTINE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: WA MD60584257) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2019-07-18 |