| NPI | 1104438902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3014910) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 3014910) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2022-02-02 |