| NPI | 1679888580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME126160) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 46985) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2016-06-14 |