| NPI | 1760742530 |
|---|---|
| Former Name | CAITLIN REBECCA GANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: VA 0102208511) |
| Additional Taxonomies | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: UT 10784090-1204) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2024-06-26 |