| NPI | 1104107507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5017987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 16065) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 16065) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2023-04-20 |