| NPI | 1568789352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MN 62719) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2013018502) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2023-06-12 |