| NPI | 1942663893 |
|---|---|
| Former Name | JULIE JACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.133849) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.028450) |
| 208000000X Pediatrics (Licence: KY TP323) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-12-14 |