| NPI | 1053739706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: CA 95000071) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704301265) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-09-17 |