| NPI | 1184941155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME141944) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 270565) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2020-10-30 |