| NPI | 1720243462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101246013) |
| Additional Taxonomies | 2080S0010X Pediatrics Sports Medicine (Licence: VA 0101246013) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2025-03-06 |