| NPI | 1437409141 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 555751) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 555751) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2020-11-30 |