| NPI | 1184056822 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G171685) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IA P49107) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2022-11-02 |