| NPI | 1578811378 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012024477) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO 2012024477) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2020-12-10 |