| NPI | 1093386625 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024426) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA RN545843) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2024-08-14 |