| NPI | 1790101558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 19149) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024171583) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-11-05 |