| NPI | 1821686148 |
|---|---|
| Former Name | JAISA EVANOFF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OK 39500) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-01-03 |
| Last Update Date | 2022-06-13 |