| NPI | 1205389798 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN CNP5226) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041401306) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209014637) | |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2025-02-10 |