| NPI | 1104570308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 10675) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310281) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-08-05 |