| NPI | 1962629766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 47035) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N1398) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2014-12-08 |