| NPI | 1619967783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 224264) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 224264) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2012-07-19 |