| NPI | 1053384669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA 104985) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MA 104985) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |