| NPI | 1104900794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: MI 4704134191) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704134191) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-10-18 |