| NPI | 1730109919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA06970700) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: NJ 25MA06970700) |
| 305S00000X Point of Service (Licence: NJ 25MA06970700) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-05-17 |