| NPI | 1750386405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-01544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704242886) |
| Enumeration Date | 2005-06-19 |
| Last Update Date | 2010-03-04 |