| NPI | 1700454550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.021970) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-06-16 |