| NPI | 1144780263 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA RN248762) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN248762) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2021-05-26 |