| NPI | 1902486780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NE 115479) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NE 84533) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-08-22 |