| NPI | 1780038737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IL 209016726) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IL 096.002869) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2023-12-29 |