| NPI | 1104012558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: RI 02548) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 223424) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2022-01-10 |