| NPI | 1235369224 |
|---|---|
| Former Name | KIMBERLY ILENE MACKIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MA 252010) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 252010) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 252010) | |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2022-07-21 |