| NPI | 1598080715 |
|---|---|
| Former Name | CAROLYN MARIE KIENSTRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX M9382) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: FL ME114874) |
| 208000000X Pediatrics (Licence: FL ME114874) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2024-03-04 |