| NPI | 1417918160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD60456680) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 36205-020) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2015-04-13 |