| NPI | 1639614415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016001983) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2003020216) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2017-01-03 |