| NPI | 1194120956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 195112) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: GA 195112) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2022-01-07 |