| NPI | 1831719095 |
|---|---|
| Former Name | COURTNEY LYON SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IN 01089873A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2023-06-29 |