| NPI | 1962051052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: TX 012556) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 012556) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX 012556) | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2019-09-10 |