| NPI | 1104587864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9771200-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 9771200-8900) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-02-10 |