| NPI | 1427314285 |
|---|---|
| Former Name | ANDREA MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS017560) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U9588) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: PA OS017560) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2024-04-25 |