| NPI | 1871757500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080H0002X (Licence: KY 42791) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 42791) |
| 208000000X Pediatrics (Licence: PA MD440383) | |
| 2080H0002X (Licence: PA MT201916) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2018-10-10 |