| NPI | 1376052365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: MO 2017032884) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MO 2017032884) |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2021-12-02 |