| NPI | 1154828127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 58436) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208000000X Pediatrics (Licence: KY TP639) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2023-09-28 |