| NPI | 1598159725 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN313157) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: GA 304) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-11-25 |