| NPI | 1811420466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 67013) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty (Licence: MN 67013) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-01-04 |