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 |