| NPI | 1629149067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL PA3581) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA3581) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2012-11-07 |