| NPI | 1063661940 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP009524) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 382009) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2012-10-08 |