| NPI | 1104265222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: TX 1018424) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 5375965052) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2022-11-21 |