| NPI | 1962551804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT D42618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D42618) |
| 208000000X Pediatrics (Licence: MD D42618) | |
| 207Q00000X Family Medicine (Licence: CT D42618) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-11-02 |