| NPI | 1982934980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MT 100821) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: MT 38901) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2016-06-10 |