| NPI | 1710300793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 76235) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MO 2014000702) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2021-08-24 |