NPI | 1669467379 |
---|---|
Former Name | TRACY LYNN LAWRENCE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: GA 057661) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35081121) |
Enumeration Date | 2005-09-19 |
Last Update Date | 2007-07-08 |