| NPI | 1104961598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX H8792) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H8792) |
| 261QP0905X Clinic/Center, Public Health, State or Local (Licence: TX H8792) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2025-10-20 |