| NPI | 1538720420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080H0002X (Licence: CA A177511) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A177511) |
| 208000000X Pediatrics (Licence: WA MD.MD.61410536) | |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2024-10-29 |