| NPI | 1649590068 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME114250) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME114250) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN15002) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2020-11-19 |