NPI | 1912054719 |
---|---|
Former Name | SUSAN M FOWLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: VA 0101249088) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2009-01001) |
208D00000X General Practice (Licence: VA 0101249088) | |
Enumeration Date | 2007-01-04 |
Last Update Date | 2024-09-03 |