| NPI | 1164796850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: ID 8561379) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WA OP60861286) |
| 208000000X Pediatrics (Licence: PA OS017575) | |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2026-07-09 |