| NPI | 1164796850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WA OP60861286) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS017575) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2021-04-08 |