| NPI | 1164051413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 34.016309) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.016309) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: KY 06118) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-08-19 |