NPI | 1912212655 |
---|---|
Former Name | CORTNEY CELESTE WILSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: NC 2012-01297) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2012-01297) |
Enumeration Date | 2010-08-17 |
Last Update Date | 2022-03-31 |