| NPI | 1225370745 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5019151) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5019151) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340896-1) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404166) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306347-1) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2025-01-24 |