| NPI | 1972034478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: LA 348423) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T2689) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2025-07-22 |