| NPI | 1902193196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 275583) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116023153) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2021-04-15 |