| NPI | 1265793822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S8888) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 274675) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2024-04-01 |