| NPI | 1013278043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 61323) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2022-03-31 |