| NPI | 1962816876 |
|---|---|
| Former Name | STEPHANIE AVITA JUGMOHAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150156) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301105575) |
| 207Q00000X Family Medicine (Licence: AZ 54346) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105575) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-08-09 |