| NPI | 1710242789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 156809) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116024926) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2022-02-21 |