| NPI | 1679729263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 126456) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208000000X Pediatrics (Licence: VA 0101246021) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2018-12-27 |