| NPI | 1104328509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A164803) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A164803) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2022-11-16 |