| NPI | 1992357974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: MI 4704290463) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704290463) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2022-04-20 |