| NPI | 1154612463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 62945) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 273683) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2022-09-18 |