| NPI | 1184801573 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301084572) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA A107664) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2021-10-14 |