| NPI | 1104103076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 30 305733) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NY 34 340816) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2016-04-19 |