| NPI | 1104068444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: CA 21230) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: NY 382047) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2013-04-03 |