| NPI | 1619389541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 66449) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP03064) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-08-30 |