| NPI | 1548067085 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA 240049) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN149522) |
| Enumeration Date | 2025-03-03 |
| Last Update Date | 2025-05-24 |