| NPI | 1649240813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R3997) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 13416) |
| 208000000X Pediatrics (Licence: FL ME130789) | |
| 208000000X Pediatrics (Licence: PR 13416) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-07-22 |