| NPI | 1225687213 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031044) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2024-09-14 |