| NPI | 1609121078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX P4264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P4264) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX P4264) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2015-06-03 |