NPI | 1245817279 |
---|---|
Former Name | KAITLIN BROOKE MARDIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: KY 05761) |
Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 05761) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-03-25 |
Last Update Date | 2024-09-25 |