| NPI | 1104459197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL F02200563) |
| Additional Taxonomies | 208VP0000X (Licence: AL 1-116836) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2025-04-09 |