| NPI | 1700144698 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 71893-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q4630) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: TX Q4630) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2019-10-11 |