| NPI | 1073514931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT 7770) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MT MED-PHYS-LIC-7770) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2026-07-21 |