| NPI | 1104703776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2025036233) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2025036233) |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-09-30 |