| NPI | 1043876824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704388643) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2026-01-23 |