| NPI | 1164193041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO F08210501) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2024-02-29 |