| NPI | 1114101805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A11026) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R982) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2022-02-11 |