| NPI | 1669815783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0081919) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2021-11-04 |