| NPI | 1679153720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 29287) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173715) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-12-06 |