| NPI | 1649788514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704372441) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3012431) |
| Enumeration Date | 2018-01-13 |
| Last Update Date | 2021-03-08 |