| NPI | 1346599776 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 338611) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R182191) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2020-09-21 |