| NPI | 1235661869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: WA MD61538659) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61538659) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2024-08-06 |