| NPI | 1366960130 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277002909) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.016240) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2024-04-02 |