| NPI | 1972791291 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.122118) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 083XDBW) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2013-09-16 |