| NPI | 1093292070 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NH 24954) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.245636) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05185) | |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2024-07-02 |