| NPI | 1407290463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09262800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 274227-1) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2019-01-10 |