| NPI | 1477230159 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN297468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA RN297468) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-01-15 |