| NPI | 1780028951 |
|---|---|
| Former Name | ANGELA LATRESHA WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX R5721) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R5721) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2024-06-13 |