| NPI | 1386925469 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95030168) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN217191) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA 95030168) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2025-01-21 |