| NPI | 1568344232 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1007931) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1007931) |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-07-23 |