| NPI | 1578964151 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011844) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 6741-33) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2016-09-14 |