| NPI | 1659422400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ME61105) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME61105) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2012-06-22 |