| NPI | 1740923283 |
|---|---|
| Former Name | CARISSA MARY WALLERICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-01725) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2024-09-12 |