| NPI | 1164828356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704249723) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI F1114225) |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2015-10-05 |