| NPI | 1295805455 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: KY 3001730) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: KY 1730P) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-01-31 |