| NPI | 1346534906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME115053) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 266602) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 266602) | |
| 208000000X Pediatrics (Licence: FL ME115053) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2014-10-20 |