| NPI | 1386533214 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11040861) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9445098) |
| Enumeration Date | 2025-07-03 |
| Last Update Date | 2025-08-05 |