| NPI | 1548793284 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 255690) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 805693) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP144798) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 903937) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2022-10-06 |