| NPI | 1053573238 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F335467-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26nj00334700) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 12461) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY f335467) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2024-12-09 |