| NPI | 1164406773 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: TX 225095) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 225095) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2011-07-12 |