| NPI | 1609890219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C10005471) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD067350L) |
| 208D00000X General Practice (Licence: DE C10005471) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2011-12-27 |