| NPI | 1760874069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2014019856) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2014019856) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2015-03-13 |