| NPI | 1053626820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F336279-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 529933-1) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2012-08-08 |