| NPI | 1134254956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 232448) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MA 232448) |
| 281PC2000X Chronic Disease Hospital, Children (Licence: MA 232448) | |
| 282NC2000X General Acute Care Hospital, Children (Licence: MA 232448) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2013-04-12 |