NPI | 1124386396 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 404843) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA12109) |
Enumeration Date | 2012-04-25 |
Last Update Date | 2012-04-25 |