| NPI | 1760800957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME147324) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 290312) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2021-11-05 |