| NPI | 1962162404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704329356) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 00000000000000000000) |
| Enumeration Date | 2021-12-24 |
| Last Update Date | 2021-12-24 |