| NPI | 1912264201 |
|---|---|
| Former Name | AUDRA JACQUELINE RYAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-22596) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.135902) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63251) | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2023-03-16 |