| NPI | 1972696177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME87220) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-05-15 |