| NPI | 1619952918 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME147006) |
| Additional Taxonomies | 207RB0002X Internal Medicine, Bariatric Medicine (Licence: LA 301880) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: LA 301880) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2022-01-31 |