| NPI | 1619266236 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: MA 270404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 123607) |
| 208000000X Pediatrics (Licence: TX Q4059) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2019-11-06 |