| NPI | 1154202182 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 84981) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NM 84981) |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-11-21 |