| NPI | 1699110973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2022044245) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.131246) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2023-01-30 |