| NPI | 1689879884 |
|---|---|
| Former Name | GWENDOLYN GAIL JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G43838) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G43838) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2016-09-20 |