| NPI | 1750791117 |
|---|---|
| Former Name | IREAL JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: LA 324028) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 324028) |
| 208000000X Pediatrics (Licence: TX R2369) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX R2369) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2024-12-17 |