NPI | 1245817279 |
---|---|
Former Name | KAITLIN BROOKE MARDIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 05761) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2021-03-25 |
Last Update Date | 2024-06-11 |