| NPI | 1932251139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP000570) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SD 0090) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2009-10-29 |