| NPI | 1215762182 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61574871) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA AP61574871) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61574871) | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-11-08 |