| NPI | 1386280105 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15108-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0994829-NP) |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2024-10-10 |