| NPI | 1508977802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AK MED54302) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: AK ak 4302) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-10-07 |