| NPI | 1356769061 |
|---|---|
| Former Name | STEPHANIE ANN BOUSQUET |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R2041) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2017-10-30 |