| NPI | 1164630992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09831300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 219333) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2018-04-24 |