| NPI | 1871723601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: WI 55520-20) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: MN 00000) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 49351) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2015-12-09 |