| NPI | 1700270972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME144297) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 276562) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-11-02 |