| NPI | 1124793807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046494) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704331072) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2022-06-02 |