| NPI | 1568790640 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 19438) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 19438) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2023-02-10 |