| NPI | 1487153300 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95015198) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 137338) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2023-08-01 |