| NPI | 1205528940 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN223677) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN223677) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-01-23 |