| NPI | 1104803980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 290866) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0001067018) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2007-07-08 |