| NPI | 1104646322 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355685) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 759053) |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2025-03-26 |