| NPI | 1629328075 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71004137A) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007678) | 
| Enumeration Date | 2012-09-13 | 
| Last Update Date | 2014-04-01 |