| NPI | 1326629189 |
|---|---|
| Former Name | CARLY RANDALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102208522) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-04-10 |