| NPI | 1275914681 |
|---|---|
| Other Name | LAUREL J WICKBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 274977) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA L-263059) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-08-10 |