| NPI | 1730447673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012004607) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75558-031) |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2012-04-29 |