| NPI | 1750657912 |
|---|---|
| Former Name | MARA KATHERINE DETERMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 237) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 289387) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2020-05-06 |