| NPI | 1982611349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A45814) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A45814) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-10-30 |