| NPI | 1659571750 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 049147) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: CT 049147) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2012-02-16 |