| NPI | 1073208757 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT 214369) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 75899) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-11-27 |