| NPI | 1356624555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: LA AP06568) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP06568) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2021-03-02 |