| NPI | 1962936559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: TX V3394) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-12-06 |