| NPI | 1518953629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA J053450) |
| Additional Taxonomies | 2084P0805X (Licence: IA J053450) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2007-12-11 |