| NPI | 1902486624 |
|---|---|
| Former Name | JAQUELIN WALLIS JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102208592) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-07-29 |