| NPI | 1053064063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA TP006109D) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP023460) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2022-01-31 |