| NPI | 1841879244 |
|---|---|
| Former Name | ALLICEN MARIE WAXLAX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81051) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2024-02-15 |