| NPI | 1659422053 |
|---|---|
| Former Name | CYNTHIA WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 41505) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD41505) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2022-05-04 |