| NPI | 1528464484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2014037193) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 2014037193) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2016-05-03 |