| NPI | 1679001861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 72526) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 11712411-1205) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2022-10-12 |