| NPI | 1437958519 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1182426) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1182426) |
| Enumeration Date | 2025-03-11 |
| Last Update Date | 2025-03-14 |