| NPI | 1982165452 |
|---|---|
| Former Name | RACHEL LOUCRETIA MANTYLA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036159331) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073694) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2022-08-16 |