| NPI | 1780052555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: GA RN212577) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: GA A0615004) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-25 |