| NPI | 1336971167 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS 906665) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MS 906665) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MS 906665) | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |