| NPI | 1780067835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 7597) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F339855-1) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2019-05-16 |