| NPI | 1992219885 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MD R150037) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R150037) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2026-03-06 |