| NPI | 1144637539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME138250) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 31153) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2021-05-20 |