| NPI | 1619223534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 135515) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0439201) |
| Enumeration Date | 2012-07-29 |
| Last Update Date | 2021-10-08 |