| NPI | 1255788097 |
|---|---|
| Former Name | MICHELLE MATHEW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S0454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10055835) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2019-07-15 |