| NPI | 1639100902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OR MD126297) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G65750) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: CA G65750) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-02-13 |