| NPI | 1508000530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A62101) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA 00A621010) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2022-03-02 |