| NPI | 1942829650 |
|---|---|
| Former Name | EMILEE LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 66632) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101287306) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2026-03-10 |