| NPI | 1700774965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 11893060-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 11893060-8900) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-09-09 |