| NPI | 1427302439 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: SC 23565) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN2263783) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2025-02-12 |