| NPI | 1154531044 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 79031) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WV 2006-2146) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-02-13 |