| NPI | 1225528318 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 9338) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 1007513) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2023-10-10 |