| NPI | 1003804360 |
|---|---|
| Former Name | TAMARA J GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 260478) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 043303) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2021-06-01 |