| NPI | 1760688105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: VA 0101247497) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101247497) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019777) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2023-03-07 |