| NPI | 1962664045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N5320) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME100606) |
| 208000000X Pediatrics (Licence: GA 061312) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2010-07-12 |