NPI | 1790164531 |
---|---|
Former Name | MADISON RUSSELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR0062721) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 59840) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-05-26 |
Last Update Date | 2019-07-11 |