| NPI | 1235428731 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 221986) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-124159) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN281139) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9465262) | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2024-05-02 |