| NPI | 1497521629 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 13509) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 13509) |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2024-08-12 |