| NPI | 1104589696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 6015058-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 6015058-4405) |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2022-04-11 |