| NPI | 1104170349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 129599) |
| Additional Taxonomies | 251S00000X (Licence: MA 256544) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2015-11-11 |