| NPI | 1730470675 |
|---|---|
| Former Name | NICOLE HARRIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2015007988) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2015-07-27 |