| NPI | 1790273464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1060357) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1060357) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX 1060357) | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2024-03-05 |