| NPI | 1649645292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.006493) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 6493) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2022-02-05 |