| NPI | 1164879904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015027443) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 20164) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |