| NPI | 1114110566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 52714) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 002802) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 52714) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2013-07-19 |