| NPI | 1245546092 |
|---|---|
| Former Name | ELIZABETH GRACE DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 57092) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101252989) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2023-04-25 |