| NPI | 1104171321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA 20121422) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MA RN2269678) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2012-07-14 |