| NPI | 1972064053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 05232) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY TP690) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2022-06-27 |