| NPI | 1134755770 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179674) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA F01201404) |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2023-08-08 |