| NPI | 1124795505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3016577) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3016577) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2022-08-04 |