| NPI | 1033505920 |
|---|---|
| Former Name | SHANNON MARIE KING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 34.013258) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.013258) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-03-30 |