| NPI | 1700307626 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 34014564)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101023609)  | 
| Enumeration Date | 2017-06-30 | 
| Last Update Date | 2024-10-16 |