| NPI | 1265229058 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2390175) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 2390175) |
| Enumeration Date | 2025-04-23 |
| Last Update Date | 2026-06-10 |