| NPI | 1073709457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA09328300) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125053691) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2013-07-24 |