| NPI | 1558592709 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5013883) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006125) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2025-02-12 |