| NPI | 1891161675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME150786) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 282127) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2022-04-01 |