| NPI | 1104080126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 7818) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MS A810274) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2012-07-04 |