| NPI | 1720124555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A88058) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 231308) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2022-01-06 |