| NPI | 1205109964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 6310-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 153325-30) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2015-05-05 |