| NPI | 1134553563 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.16858-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 810470) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2022-08-26 |