| NPI | 1801830708 |
|---|---|
| Former Name | TIFFANIE D MICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 83446) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL OS9813) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-07-14 |