| NPI | 1376538645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME121088) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 207572) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2016-11-01 |