| NPI | 1104080472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N2507) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD435055) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2015-05-27 |