| NPI | 1487099354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 608533) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208000000X Pediatrics (Licence: NE 29685) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-09-20 |