| NPI | 1104801992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304186) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 304186) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2018-05-22 |