| NPI | 1033669734 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71015406A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.019996) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2025-01-14 |