| NPI | 1609558998 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN295140) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN295140) |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2024-07-19 |