| NPI | 1437705522 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1056825) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009235A) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2022-01-03 |