| NPI | 1366937229 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT 132085) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 5901) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2021-07-21 |