| NPI | 1336733807 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R149988) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP023297) |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2025-01-16 |