| NPI | 1104161264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2303105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18033) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2018-06-11 |