| NPI | 1508252040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 566824-1) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NJ 26NR15406000) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-04-10 |