| NPI | 1114959103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704133105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI JK133105) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-09-10 |