| NPI | 1104566025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC LL87944) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101285010) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-06-18 |