| NPI | 1063665990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P1266) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301093478) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2022-04-20 |