| NPI | 1992039960 |
|---|---|
| Former Name | JACLYN LOUISE LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P5320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10034544) |
| 208000000X Pediatrics (Licence: TX BP10034544) | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2019-06-25 |