| NPI | 1700014396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2006019137) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-74930-032) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2011-06-13 |