| NPI | 1275407579 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC009327) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9561978) |
| Enumeration Date | 2025-10-01 |
| Last Update Date | 2026-07-20 |