| NPI | 1134596695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: WA MD61086246) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 295657) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2021-07-01 |