| NPI | 1770562464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME100724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-082408) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2015-04-15 |