NPI | 1902127442 |
---|---|
Former Name | AMANDA RAE GOODENBERGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: NE 30277) |
Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-36564) |
208000000X Pediatrics (Licence: MO 2012008172) | |
Enumeration Date | 2010-06-18 |
Last Update Date | 2018-01-24 |