| NPI | 1962743237 |
|---|---|
| Former Name | LAURA LYNN RIVERA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S3576) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2018015584) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2023-09-05 |