| NPI | 1558076695 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5020761) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5020761) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-02-04 |