| NPI | 1104230697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ Ap5642) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ F0614039) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2022-10-14 |