| NPI | 1154811545 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 2023-03261) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 68244) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2024-04-26 |