| NPI | 1811314966 |
|---|---|
| Former Name | JACQUELINE MARIE HAVENS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088F0040X Urology Female Pelvic Medicine and Reconstructive Surgery (Licence: CA A160406) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-01-25 |