| NPI | 1619097037 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 262904-1) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 225620) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2011-10-23 |