| NPI | 1154371292 |
|---|---|
| Former Name | MARIA THERESA SAN AGUSTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C51083) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 205725-1) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |