| NPI | 1790774354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F3700121) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F3301131) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2007-07-08 |