| NPI | 1972792950 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 15648) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 15648) | 
| Enumeration Date | 2007-10-16 | 
| Last Update Date | 2019-07-31 |