| NPI | 1306568902 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS 000000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 905742) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2024-09-25 |