| NPI | 1063418507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA VP007041B) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F3344401) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2009-07-20 |