| NPI | 1396386637 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT 158377) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001650) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2020-08-11 |