| NPI | 1417795873 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0137296) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 084579-21) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 084579-23) | |
| Enumeration Date | 2024-07-18 |
| Last Update Date | 2024-08-21 |