| NPI | 1609372762 |
|---|---|
| Former Name | SAMANTHA WEATE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101267866) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-08-10 |