| NPI | 1518537208 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704352498) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28072109A) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |