| NPI | 1053724575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R3408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT016056) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2019-11-04 |