| NPI | 1912519638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11041870) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA20602) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2025-08-26 |