| NPI | 1104157601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A110463) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A110463) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2015-08-25 |