| NPI | 1336649144 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9173370) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9173370) |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2018-07-11 |