| NPI | 1104311778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: LA AP09973) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 9331214) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-10-04 |