| NPI | 1780677419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD27140) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M1772) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2011-10-11 |