| NPI | 1114459781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U7455) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102205506) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2024-04-03 |