| NPI | 1467604645 |
|---|---|
| Former Name | KATHERINE ETTEN LIVELY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 53526-021) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-10-19 |
| Last Update Date | 2023-03-03 |