NPI | 1366816753 |
---|---|
Former Name | JENNIE SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60546515) |
Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD-18403) |
208000000X Pediatrics (Licence: NC 32579) | |
Enumeration Date | 2015-11-23 |
Last Update Date | 2018-06-15 |