| NPI | 1619254356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN119790) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AL 1-067844) |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2012-08-10 |