| NPI | 1063181246 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11027247) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 904826) | 
| Enumeration Date | 2021-09-10 | 
| Last Update Date | 2023-09-14 |