| NPI | 1104054519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F335960) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 335960) |
| 363L00000X Nurse Practitioner (Licence: NY F335960) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2010-11-11 |