| NPI | 1083200182 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014662) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 346991) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2025-02-05 |