| NPI | 1891063822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD 2011002215) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R-149483) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2012-09-12 |