| NPI | 1750781936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME147428) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 276519) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2021-12-13 |