| NPI | 1710114178 |
|---|---|
| Former Name | SHANNON MICHELLE GIFFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WI 62385) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-5733) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2014-07-03 |