| NPI | 1942594056 |
|---|---|
| Former Name | KELLY ANN WATERHOUSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q0275) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2018-08-06 |