| NPI | 1134513385 |
|---|---|
| Former Name | ELISE BRIANNE PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD463652) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2018-06-27 |