| NPI | 1336487784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME166907) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 276845) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2024-10-28 |