| NPI | 1366073785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3014289) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: KY 3014289) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-04-15 |