| NPI | 1730652850 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020012)  | 
| Additional Taxonomies | 208D00000X General Practice (Licence: PA F11180788)  | 
| Enumeration Date | 2019-01-11 | 
| Last Update Date | 2022-09-20 |