| NPI | 1215024146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 65526) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 228004) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MD2016-0186) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2019-09-05 |