| NPI | 1962804963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F339024-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704273933) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2014-11-03 |