| NPI | 1083038541 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013468) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP013468) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2022-01-07 |