| NPI | 1073920716 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 860482) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS R860482) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2024-02-14 |