| NPI | 1710976121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R084503) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R084503) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP009940) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2015-11-12 |