| NPI | 1205124849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 062410) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 062410) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2019-06-13 |