| NPI | 1124904156 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2339361) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2339361) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2026-04-14 |