| NPI | 1508346602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T8757) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 208D00000) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2022-08-09 |