| NPI | 1558113795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 002150) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 002150) |
| 363A00000X Physician Assistant (Licence: PR 002150) | |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2025-01-02 |