| NPI | 1063707032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 170279) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN170279) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2012-09-20 |