| NPI | 1417211830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012416) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: FL 1267952) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-10-04 |