| NPI | 1104899483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 18046) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F334655-1) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2021-11-12 |