| NPI | 1104983592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA11519000) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 192541) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2025-08-09 |