| NPI | 1790936128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704249736) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 18930) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2012-10-15 |