| NPI | 1639732167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME146340) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-11-24 |