| NPI | 1134455330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: TX S3451) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 272566) |
| 208000000X Pediatrics (Licence: NY 272566) | |
| 208D00000X General Practice (Licence: FL ME152234) | |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2022-05-23 |