| NPI | 1053077628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 11015985) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015985) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-01-12 |