| NPI | 1639121882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 4570P) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IL 209006254) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-03-01 |