| NPI | 1356476105 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: PA TP0011576) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN222426L) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-07-30 |