| NPI | 1740289867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO CO42100) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00036886) |
| 208000000X Pediatrics (Licence: NM MD20030711) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-12-04 |