| NPI | 1609438043 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH 34483) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN165323) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 235164) | |
| Enumeration Date | 2019-07-06 |
| Last Update Date | 2025-02-19 |