| NPI | 1790053510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 19103) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 29318R) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2022-02-02 |