| NPI | 1710483557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME154772) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 309306) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-07-07 |