| NPI | 1619311438 |
|---|---|
| Former Name | AMANDA LEISH VICE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 301709) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 29920) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2016-05-18 |