| NPI | 1093040321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: SC 87858) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MB09091200) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2022-11-09 |