| NPI | 1295584076 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 13545) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 199378) |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-07-24 |