| NPI | 1114787074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2024023296) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11960) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-08-26 |