| NPI | 1063672160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 54010) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 261675) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2022-09-07 |