| NPI | 1659075836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704342265) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4704342265) |
| 207Q00000X Family Medicine (Licence: MI 4704342265) | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-05-24 |