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 |