| NPI | 1568859734 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 6157) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 560) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2017-03-10 |