| NPI | 1164955191 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61256268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA10891800) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-05-10 |