| NPI | 1295155380 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD479525) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.131933) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: NJ 25MA10618500) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.131933) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-10-13 |