| NPI | 1114286184 |
|---|---|
| Former Name | ELYSSA RENEE RUBERTINO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 04134) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q4347) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2020-10-11 |