| NPI | 1508758814 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95036166) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95036166) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2026-05-21 |