| NPI | 1316403850 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN615895) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-03-14 |