| NPI | 1912988932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3004166) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 4166P) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2013-10-09 |