| NPI | 1306468889 |
|---|---|
| Former Name | AMBER DALE RUSSO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036164848) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: IL 036164848) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2023-06-21 |