| NPI | 1356640536 |
|---|---|
| Former Name | KRYSTAL AMY BALLA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.136458) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.059749) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2014-11-18 |