| NPI | 1720080583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: SD CP000110) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0221) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2015-12-29 |