| NPI | 1679956494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 59199) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT209791) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2019-10-24 |