| NPI | 1801154000 |
|---|---|
| Former Name | KATHRYN GANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WI 61745-20) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.126176) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-07-03 |