| NPI | 1104360122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ AP9704) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ NP9704) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2019-06-21 |