| NPI | 1053879411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704248973) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704248976) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2019-06-25 |