| NPI | 1568355105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 30315) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 30315) |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-09-15 |