| NPI | 1104074707 |
|---|---|
| Former Name | ALLYSON REGINE SELF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A108876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08463800) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2019-09-16 |