| NPI | 1962492082 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201618) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NC 201618) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2018-01-12 |