| NPI | 1083612345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 213299) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 213299) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2013-08-27 |