| NPI | 1508503897 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3017447) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3017447) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-07-25 |