| NPI | 1417023151 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY RN414664) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 301806ANP) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY FNP332903) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |