| NPI | 1629369608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 262466) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 53181) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2018-03-17 |