| NPI | 1154091916 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R39053) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R39053) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2021-10-07 |