| NPI | 1447836168 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 904376) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS F12200898) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2021-07-23 |