| NPI | 1003940503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 20391) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 191384) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2012-01-20 |