| NPI | 1609762996 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 383888) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY N09291) |
| 163W00000X Registered Nurse (Licence: GA RN332331) | |
| Enumeration Date | 2025-06-14 |
| Last Update Date | 2026-01-15 |