| NPI | 1588640163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.148810) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: SC 23131) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2023-10-26 |