| NPI | 1831712546 |
|---|---|
| Former Name | TARA GANELLE HENDRICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-17016) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2023-08-04 |