| NPI | 1083159099 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 901897) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R820497) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2017-05-06 |