| NPI | 1518788306 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 15959) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 15959-33) |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2025-01-27 |