| NPI | 1508327651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61263708) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: WA MD61263708) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-10-26 |