| NPI | 1730428632 |
|---|---|
| Former Name | AMANDA KATHLEEN VENETTIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101020303) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2017-03-08 |