| NPI | 1306893920 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN5448) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9240703) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2009-03-18 |