| NPI | 1538653738 |
|---|---|
| Former Name | BETHANY CARLOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD210001398) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL52596) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2026-05-20 |