| NPI | 1477765113 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX M7903) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M7903) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-04 | 
| Last Update Date | 2012-04-06 |