| NPI | 1174132112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS MITC-BK3CE9) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 862935) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-08-07 |