| NPI | 1407263494 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2014028446) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2007005731) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2021-03-30 |