| NPI | 1104972710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD29395) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO 46554) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1770) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-04-07 |