| NPI | 1609102771 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME105727) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 34096) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2009-10-26 |