| NPI | 1609157692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA04944000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 170130-1) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |