| NPI | 1588265045 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA 2317372) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2317372) |
| 163W00000X Registered Nurse (Licence: CT 156507) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 9592) | |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2022-05-18 |