| NPI | 1619067584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 12946) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9407562) |
| 363L00000X Nurse Practitioner (Licence: ND R27665) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-03-01 |