| NPI | 1629395520 |
|---|---|
| Former Name | TRACIE SHENELLE CALLOWAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-8026) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX P7404) |
| Enumeration Date | 2010-05-01 |
| Last Update Date | 2020-04-03 |