| NPI | 1609879337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MO 2008015366) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2008015366) |
| Enumeration Date | 2005-05-26 |
| Last Update Date | 2023-03-07 |