| NPI | 1619630159 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 041331492) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: IL 041331492) |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2024-04-11 |