| NPI | 1467810861 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000909) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LG-0000909) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024183187) | |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2025-01-15 |