| NPI | 1053494625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA02943000) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 25MA02943000) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2015-11-30 |