| NPI | 1184650012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 232009) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 232009) |
| 363L00000X Nurse Practitioner (Licence: NH 046907-23) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2012-02-03 |