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 |