| NPI | 1407172372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA 18494) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 18494) |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2010-04-16 |