| NPI | 1568849164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 295484) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: NY 295484) |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2024-12-15 |