| NPI | 1104507870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024187640) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 34621) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2025-01-07 |