| NPI | 1649733619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 55788) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM 55788) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2022-08-08 |