| NPI | 1376054775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1022076) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704276935) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2021-05-11 |