| NPI | 1659643450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: UT 6191949-4405) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 6191949-3102) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2015-08-10 |