| NPI | 1013778893 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-188967) |
| Additional Taxonomies | 208800000X Urology (Licence: MT NUR-APRN-LIC-188967) |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: MT NUR-APRN-LIC-188967) | |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |