| NPI | 1699192500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 312055) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 56397) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-03-16 |