| NPI | 1790755403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 14300) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704248221) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-12-06 |