| NPI | 1609287796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F338692-1) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: NY F338692-1) |
| 261QS1000X Clinic/Center Student Health (Licence: NY F338692-1) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2014-05-12 |