| NPI | 1588082028 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R1835)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 73426-20)  | 
| Enumeration Date | 2014-04-02 | 
| Last Update Date | 2021-10-07 |