| NPI | 1104822295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 1505) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 24167669) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2011-10-27 |