| NPI | 1861932600 |
|---|---|
| Former Name | AMANDA BEACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS020488) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2022-05-11 |