| NPI | 1407050297 |
|---|---|
| Former Name | LISA RENEE ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C162286) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101245344) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-12-09 |