| NPI | 1063764405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277.000862) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.009833) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2022-09-06 |