| NPI | 1760968218 |
|---|---|
| Former Name | CHRISTINE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 66342) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 39) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2021-06-22 |