| NPI | 1598175762 |
|---|---|
| Former Name | REBECCA RENEE ROACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 15932) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0062827) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2025-01-22 |