| NPI | 1144036351 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11035065) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11035065) |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2025-01-07 |