| NPI | 1578105789 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012814)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95012814)  | 
| Enumeration Date | 2019-10-09 | 
| Last Update Date | 2020-09-02 |