| NPI | 1720320062 |
|---|---|
| Former Name | COLLEEN MARTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080H0002X (Licence: WA MD61043121) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9148185-1205) |
| 208000000X Pediatrics (Licence: WA MD61043121) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2023-05-12 |