| NPI | 1609154798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX W0708) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011035311) |
| Enumeration Date | 2011-07-24 |
| Last Update Date | 2026-04-30 |