NPI | 1700990827 |
---|---|
Former Name | LEAH LANE SHUTT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: SC 30653) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200600241) |
Enumeration Date | 2006-08-18 |
Last Update Date | 2023-03-07 |