| NPI | 1104387950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 13352563-1204) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102206425) |
| 208000000X Pediatrics (Licence: VA 0102206425) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-08-15 |