| NPI | 1164015947 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11011506) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 11011506) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2021-02-15 |