| NPI | 1023454089 | 
|---|---|
| Former Name | SAMANTHA WHITE | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: ME DO2932) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2013-05-17 | 
| Last Update Date | 2022-07-21 |