| NPI | 1114318136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1069667) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012579) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2023-02-06 |