NPI | 1124653589 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179589) |
Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0024179589) |
Enumeration Date | 2020-03-05 |
Last Update Date | 2022-08-16 |