| NPI | 1760968804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: UT 911041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 9111041-4405) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2020-11-12 |