| NPI | 1447544697 |
|---|---|
| Former Name | TARA DANIELLE WEDIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD451398) |
| Additional Taxonomies | 2080H0002X (Licence: PA MD451398) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2019-08-21 |