| NPI | 1730753831 |
|---|---|
| Former Name | CARLEE BREEANN HENDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 0409R) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2022-02-23 |