| NPI | 1962694042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101245478) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101245478) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2018-05-08 |