| NPI | 1164580320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-00447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 30562) |
| 208000000X Pediatrics (Licence: AZ 30562) | |
| 208000000X Pediatrics (Licence: NC 2007-00447) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-11 |