| NPI | 1972502870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 053268) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IL 209-006338) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2012-07-31 |