| NPI | 1669886206 |
|---|---|
| Former Name | SVETLANA PUSTILNIKOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA A163484) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2019-08-26 |