| NPI | 1417320896 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003442) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95059926) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2024-02-15 |