| NPI | 1902548571 |
|---|---|
| Former Name | KATELYN ELIZABETH JAKYMA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026878) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2951000887) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2023-05-29 |