| NPI | 1194238576 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024175051) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024175051) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175051) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024175051) | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2025-01-14 |