| NPI | 1831777465 |
|---|---|
| Former Name | JAI PONMALI PHOTAVATH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: PA MT230885) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2024-06-03 |