| NPI | 1497856264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME128787) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 204167) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-11-28 |