| NPI | 1073839924 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 420983) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 420983) |
| Enumeration Date | 2010-04-18 |
| Last Update Date | 2021-03-24 |