| NPI | 1134917222 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11038011) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11038011) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-06-13 |