| NPI | 1972580769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 211749-4405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 211749-4405) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2018-10-19 |