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 |