| NPI | 1427378223 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2017005255) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 5377930071) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2020-12-17 |