| NPI | 1295107183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: PA MD479162) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: NJ 25MA09741800) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2022-08-25 |