| NPI | 1659021657 |
|---|---|
| Former Name | AMBER NICHOLE DOMAKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 76405) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML61294831) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-07-17 |