| NPI | 1245625060 |
|---|---|
| Former Name | JESSICA ANN MODOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: CA A143910) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2021014850) |
| 208000000X Pediatrics (Licence: CA A143910) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2024-04-27 |