| NPI | 1295584076 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LG-0013260) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 199378) |
| 163W00000X Registered Nurse (Licence: DE L1-0075865) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 13545) | |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2025-08-25 |