| NPI | 1912311143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PR 21718) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PR 31205R) |
| 208000000X Pediatrics (Licence: LA 306467) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2022-07-21 |