| NPI | 1558809046 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0132310) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2268640) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2022-07-21 |