| NPI | 1316254642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2010030114) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 5375200112) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2010-09-08 |