| NPI | 1740300722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 301024) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F301024) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2019-05-07 |