| NPI | 1194165209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2013021217) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 53-76026-081) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2015-05-22 |