| NPI | 1558755538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080H0002X (Licence: MA 291490) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: MA 291490) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-01-02 |