| NPI | 1174882856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 203654-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 203654-8900) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-05-15 |