| NPI | 1609209543 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A117791) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA F07131130) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2022-03-30 |