| NPI | 1376015602 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3012969) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 3012969) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2024-10-29 |